In the treatment of shoulder pathologies such as tendonitis, impingement syndrome, tendonosis, rotator cuff tears, adhesive surgery, etc., post-operative scarring is a common occurrence. Such post-operative scarring can result in a limited range of motion in the shoulder.
More particularly, such post-operative scarring can result in contracture of the joint capsule and the surrounding soft tissue structures, which can itself result in a limited range of motion in the shoulder. In addition, the contracture of the posterior capsule can prevent the rotator cuff from properly stabilizing and depressing the humeral head in abduction. This can, in turn, create a cam effect of the humeral head in abduction, thereby resulting in further limited range of motion, as well as instability of the shoulder. Thus, post-operative scarring is a common source of frustration for patients, since a limited range of motion in the shoulder can lead to a restricted lifestyle.
The current method for restoring a patient's range of motion is through physical therapy, which generally involves joint manipulation, soft tissue stretching and muscle strengthening. However, current methods of soft tissue stretching generally suffer from the fact that, due to the limited time available for a typical therapy session, substantial stretching must be effected at each therapy session. This stretching pushes the limits of the soft tissue, so that the patient frequently experiences significant discomfort during the therapy. Significantly, when the patient experiences this painful traumatic stretching, muscle spasms can occur. These muscle spasms are counterproductive to the stretching process, since they create an antagonistic force which inhibits stretching and thereby undermines the physical therapy. In some cases the pain and muscle spasms experienced by the patient can become so problematic as to require a halt to the normal physical therapy protocol. And in some extreme cases, such pain and muscle spasms may be so severe as to require closed manipulation of the shoulder joint under anesthesia and/or arthroscopic or open capsular releases.
We have determined that, if the soft tissue can be stretched, and then maintained in that stretched condition long enough for any muscle spasms to subside and for muscular relaxation to occur, the soft tissue can then be stretched further in a gentle, relaxed manner so as to facilitate highly effective physical therapy. In other words, we have determined that effective stretching of the capsule can best be achieved by stretching the soft tissue to a first extent, holding the soft tissue in that position for a period of time so that the muscles return to a relaxed state, and then stretching the soft tissue further.
Unfortunately, the methods and apparatus currently used in stretching the soft tissue—either because of the tight time constraints of a typical physical therapy session or because of the inherent mechanics of the apparatus—provide no effective way to stretch the soft tissue, maintain the soft tissue in that stretched condition long enough for muscular relaxation to occur, and then stretch the soft tissue further. Thus, current methods and apparatus do not allow the muscle to relax and cease to be an antagonistic force, which is counterproductive to physical therapy.
Thus, there is an urgent need for an improved method and apparatus which allows the patient's soft tissue to be stretched, held in this stretched condition long enough for muscular relaxation to occur, and then stretched further in a gentle, relaxed manner so as to facilitate effective physical therapy.